The Basic Rule: Age 65 or Disability

You can get Medicare if you are 65 or older, or if you are under 65 and have been receiving Social Security Disability Insurance (SSDI) for at least 24 months, or if you have end-stage renal disease (ESRD) or ALS. Most people fall into the age 65 category. The program does not check your income or savings — only your age and work history matter.

If you are not yet 65 and do not have SSDI, ESRD, or ALS, you cannot get Medicare. You would need to look at other coverage options, such as the Affordable Care Act marketplace or Medicaid, depending on your state and income.

Key Takeaways

  • You become may be able to access for Medicare automatically at 65 if you or your spouse worked and paid Medicare taxes for at least 10 years (40 quarters).
  • If you are under 65, you can get Medicare only if you have been on SSDI for 24 months, have end-stage renal disease, or have ALS.
  • You do not have to be retired to get Medicare at 65 — you can still be working and earning any amount.
  • If you did not work long enough in the United States, you may still get Medicare based on your spouse's or ex-spouse's work record.
  • You must sign up during your enrollment window or face a permanent penalty on your premiums.

The 10-Year Work History Requirement

To get Medicare at 65, you need 40 quarters of work history — that is 10 years of paying Medicare taxes. A quarter is roughly three months. You do not have to have worked all 40 quarters in a row, and you do not have to have worked recently. If you worked 10 years at any point in your life and paid Medicare taxes, you meet this requirement.

Your work history is tracked by Social Security. You can check your record by creating an account at ssa.gov or by calling Social Security at 1-800-772-1213. Social Security will tell you how many quarters you have earned. If you are close to 40 quarters but not quite there, you may be able to work a bit longer to reach it.

If you worked outside the United States, those years usually do not count toward the 40 quarters. There are some exceptions for people who worked in countries with social security agreements with the United States, but this is rare and requires checking with Social Security directly.

Getting Medicare Based on a Spouse's Work Record

If you did not work 10 years yourself, you may still get Medicare at 65 based on your spouse's work history. Your spouse must be 62 or older and must have 40 quarters of work history. You must be married and living together, or divorced but married for at least 10 years.

If your spouse is still working and has not yet signed up for Medicare, you can still use their record. You do not need their permission, and it does not affect their benefits. Social Security will verify their work history when you explore.

If you are divorced, the same rule applies — you can use an ex-spouse's record if you were married for at least 10 years, you are at least 65, and you are not currently married to someone else. You do not need to contact your ex-spouse.

Medicare for People Under 65 With Disabilities or Serious Illness

If you are under 65 and have been receiving SSDI for 24 months, you become may be able to access for Medicare. The 24 months starts from when Social Security first approved your disability claim, not from when you applied. You do not have to wait an additional 24 months after turning 65 — once the 24 months is up, you can get Medicare right away.

If you have end-stage renal disease (ESRD) — permanent kidney failure requiring dialysis or a transplant — you can get Medicare regardless of age or work history. You become may be able to access the month your dialysis treatment starts, or the month you have a kidney transplant, whichever comes first. If you are on a transplant waiting list, you become may be able to access the month you are listed.

If you have ALS (amyotrophic lateral sclerosis, also called Lou Gehrig's disease), you can get Medicare when ready upon diagnosis, without waiting 24 months. You do not need to be on SSDI first.

What Happens When You Turn 65

Three months before you turn 65, Social Security will mail you a notice telling you that you are may be able to access for Medicare. You do not have to do anything to get Part A (hospital insurance) — it starts automatically the month you turn 65, as long as you have the required work history. You will receive your Medicare card in the mail about two weeks before your 65th birthday.

Part B (medical insurance) is different. You must sign up for it, and there is a important date. If you sign up during your initial enrollment window — the three months before you turn 65, the month you turn 65, and the three months after — you pay the standard premium. If you miss this window and do not have other coverage, you will pay a higher premium for as long as you have Medicare. This penalty is permanent and does not go away.

If you are still working at 65 and have health insurance through your job, you may be able to delay Part B without penalty. This is called the special enrollment period. You must have coverage based on current employment — coverage for a retired spouse does not count. When you do sign up for Part B, you will need to provide proof that you had employer coverage.

Checking Your Work History Before You Turn 65

Do not wait until you are 65 to check whether you have enough work history. If you are within a few years of 65, create a my Social Security account at ssa.gov and review your earnings record. The record shows each year you worked and how much you earned. Check it for errors — if an employer did not report your wages correctly, you can ask Social Security to fix it, but this takes time.

If you are missing quarters, you have options. You can work longer to earn more quarters. You can check whether you may have access to based on a spouse's record. Or you can contact Social Security to discuss your situation. Call 1-800-772-1213 to speak with someone who can review your specific record and tell you what you need to do.

If you are a non-citizen, your work history still counts the same way. You do not need to be a U.S. citizen to get Medicare, but you do need to be a permanent resident (green card holder) or have a valid visa status. Undocumented immigrants cannot get Medicare.

Frequently Asked Questions

Can I get Medicare if I never worked?

No, unless you are under 65 and have SSDI, ESRD, or ALS. If you are 65 or older and never worked, you cannot get Medicare. You may be able to get Medicaid instead, depending on your state and income. Contact your state Medicaid office to learn what programs may be available to you.

What if I worked in another country?

Work outside the United States usually does not count toward the 40 quarters. However, some countries have social security agreements with the United States that allow work to count. Call Social Security at 1-800-772-1213 and ask whether your country has an agreement. Bring your work records or employment documents.

Do I lose Medicare if I go back to work after 65?

No. Once you have Medicare, you keep it no matter how much you earn or whether you work. You can work full-time and still have Medicare. Your earnings do not affect your Medicare coverage or premiums.

Can I get Medicare if I am divorced?

Yes, if you were married for at least 10 years and your ex-spouse has 40 quarters of work history. You do not need their permission or agreement. You can use their record to get Medicare at 65, even if they have not yet signed up themselves.

What if Social Security says I do not have enough quarters?

Ask Social Security to review your record for errors — sometimes employers do not report wages correctly. If your record is correct and you are short a few quarters, you can work longer to earn them. If you cannot work, ask whether you may have access to based on a spouse's or ex-spouse's record. If none of these explore, you cannot get Medicare, but you may be able to get coverage through the Affordable Care Act marketplace or Medicaid.